U.S. patent application number 14/165193 was filed with the patent office on 2014-07-24 for multi-display bedside monitoring system.
This patent application is currently assigned to Spacelabs Healthcare. The applicant listed for this patent is Spacelabs Healthcare. Invention is credited to Michael Brendel, Jeffrey Jay Gilham, Patrick Jensen, Katherine Stankus.
Application Number | 20140203937 14/165193 |
Document ID | / |
Family ID | 44646777 |
Filed Date | 2014-07-24 |
United States Patent
Application |
20140203937 |
Kind Code |
A1 |
Gilham; Jeffrey Jay ; et
al. |
July 24, 2014 |
Multi-Display Bedside Monitoring System
Abstract
The present specification discloses systems and methods for
patient monitoring using a multitude of display regions, at least
two of which have the capability to simultaneously display real
time patient waveforms and vital statistics as well as provide
display for local and remote software applications. In one example,
a primary display shows real time patient waveforms and vital
statistics while a customizable secondary display shows trends,
cumulative data, laboratory and radiology reports, protocols, and
similar clinical information. Additionally, the secondary display
can launch local and remote applications such as entertainment
software, Internet and email programs, patient education software,
and video conferencing applications. The dual display allows
caregivers to simultaneously view real time patient vitals and
aggregated data or therapy protocols, thereby increasing hospital
personnel efficiency and improving treatment, while not
compromising the display of critical alarms or other data.
Inventors: |
Gilham; Jeffrey Jay;
(Sammamish, WA) ; Jensen; Patrick; (Sammamish,
WA) ; Brendel; Michael; (Issaquah, WA) ;
Stankus; Katherine; (Woodinville, WA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Spacelabs Healthcare |
Snoqualmie |
WA |
US |
|
|
Assignee: |
Spacelabs Healthcare
Snoqualmie
WA
|
Family ID: |
44646777 |
Appl. No.: |
14/165193 |
Filed: |
January 27, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13052883 |
Mar 21, 2011 |
8674837 |
|
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14165193 |
|
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61315967 |
Mar 21, 2010 |
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Current U.S.
Class: |
340/573.1 |
Current CPC
Class: |
G16H 40/67 20180101;
G16H 50/20 20180101; G09G 2380/08 20130101; G16H 40/63 20180101;
G06F 3/1438 20130101; A61B 5/002 20130101; G16H 15/00 20180101;
G16H 10/60 20180101 |
Class at
Publication: |
340/573.1 |
International
Class: |
G06F 19/00 20060101
G06F019/00 |
Claims
1. A display system for displaying critical patient data and/or
non-critical data, comprising: a plurality of ports configured to
connect said display system to a plurality of physiological
parameter measuring devices; at least one port configured to
connect said display system to at least one network; a display
screen comprising a plurality of pixels divided into a first
display region and a second display region, wherein said first
display region displays data from a first video buffer and wherein
said second display region displays data from a second video
buffer; and a controller for directing non-critical data to said
first video buffer and said second video buffer, wherein, in
response to a triggering event, said controller stops directing
non-critical data to the first video buffer and directs critical
patient data to the first video buffer.
2. The display system of claim 1 wherein the triggering event is at
least one of an alarm, a physiological parameter exceeding a
predefined threshold, a passage of time, a physiological parameter
falling below a predefined threshold, or a detected disconnection
of a sensor.
3. The display system of claim 2 wherein, in response to the
triggering event, the controller automatically stops directing
non-critical data to the first video buffer and directs critical
patient data to the first video buffer.
4. The display of claim 2 wherein the detected disconnection of a
sensor comprises a disconnected ECG electrode.
5. The display of claim 2 wherein the physiological parameter
falling below a predefined threshold comprises a weakening pulse
oximeter signal.
6. The display of claim 2 wherein, in response to the triggering
event, the controller stops directing non-critical data to the
second video buffer and directs critical patient data to the second
video buffer.
7. The display system of claim 6 wherein the triggering event is at
least one of an alarm, a physiological parameter exceeding a
predefined threshold, a passage of time, a physiological parameter
falling below a predefined threshold, or a detected disconnection
of a sensor.
8. The display system of claim 1 wherein the non-critical data
comprises laboratory data, prescribed medication, patient
educational data, advertising, historical patient health status,
historical alarm data, video data, audio data, or email data.
9. The display system of claim 8 wherein the non-critical data is
transmitted to the display system, via the at least one network and
said at least one port, from a remotely located database.
10. The display system of claim 8 wherein the critical patient data
comprises at least one of data a) indicative of a patient's health
status requiring immediate attention from a health care provider,
b) indicative of a patient's health status which should be brought
to the attention of a health care provider but which is not
time-critical, or c) designated by a health care provider as
requiring substantially constant display.
11. The display system of claim 10 wherein the physiological
parameter measuring devices comprise ECG, blood pressure,
SpO.sub.2, cardiac output, temperature, capnography, BIS,
SvO.sub.2, or EEG measuring devices.
12. A display system for displaying critical patient data and
non-critical data, comprising: a plurality of ports configured to
connect said display system to a plurality of physiological
parameter measuring devices; at least one port configured to
connect said display system to at least one network; a display
screen comprising a plurality of pixels divided into a first
display region, having a first pixel count, and a second display
region, having a second pixel count, wherein said first display
region displays data from a first video buffer and wherein said
second display region displays data from a second video buffer; and
a controller for directing non-critical data to said first video
buffer and for directing critical patient data to said second video
buffer, wherein, in response to a triggering event, said controller
decreases the first pixel count, thereby decreasing the first
display region size, and increases said second pixel count, thereby
increasing said second display region size.
13. The display system of claim 12 wherein the triggering event is
at least one of an alarm, a physiological parameter exceeding a
predefined threshold, a passage of time, a physiological parameter
falling below a predefined threshold, or a detected disconnection
of a sensor.
14. The display of claim 13 wherein the detected disconnection of a
sensor comprises a disconnected ECG electrode.
15. The display system of claim 12 wherein the non-critical data
comprises laboratory data, prescribed medication, patient
educational data, advertising, historical patient health status,
historical alarm data, video data, audio data, or email data.
16. The display system of claim 15 wherein the non-critical data is
transmitted to the display system, via the at least one network and
said at least one port, from a remotely located database.
17. The display system of claim 15 wherein the critical patient
data comprises at least one of data a) indicative of a patient's
health status requiring immediate attention from a health care
provider, b) indicative of a patient's health status which should
be brought to the attention of a health care provider but which is
not time-critical, or c) designated by a health care provider as
requiring substantially constant display.
18. The display system of claim 17 wherein the physiological
parameter measuring devices comprise ECG, blood pressure,
SpO.sub.2, cardiac output, temperature, capnography, BIS,
SvO.sub.2, or EEG measuring devices.
19. The display system of claim 18 wherein the critical patient
data comprises a predefined set of values generated in real-time
from said physiological parameter measuring devices.
20. A method for concurrently displaying non-critical data and a
multitude of patient physiological parameters being monitored in
real-time on a display screen, having a plurality of pixels divided
into a first display region with a first pixel count and a second
display region with a second pixel count, comprising: Receiving
monitored data from a plurality of patient physiological
parameters; Receiving stored data from at least one data network;
Buffering critical patient data in a first video buffer; Buffering
non-critical data in a second video buffer; Displaying critical
patient data in said first display region, wherein said first
display region is in data communication with said first video
buffer and not said second video buffer; Displaying non-critical
data in said second display region, wherein said second display
region is in data communication with said second video buffer and
not said first video buffer; and In response to a triggering event,
decreasing the first pixel count, thereby decreasing the first
display region size, and increasing said second pixel count,
thereby increasing said second display region size.
21. (canceled)
22. (canceled)
23. (canceled)
Description
CROSS-REFERENCE
[0001] The present specification relies on U.S. Patent Provisional
No. 61/315,967, filed on Mar. 21, 2010, and incorporated herein by
reference.
FIELD OF INVENTION
[0002] The present specification relates to patient monitoring
systems. More particularly, the present specification relates to a
system and method of patient monitoring using dual display bedside
monitors that are connected to a hospital information system and
have the capability to simultaneously display real time patient
waveforms and vital statistics as well as provide display for local
and remote software applications.
BACKGROUND OF THE INVENTION
[0003] Conventional patient bedside monitors are connected to
various vital statistics measuring/monitoring devices and display
the real time patient vital statistics, such as pulse rate and
blood pressure, among other variables, continuously. Usually, the
displayed vital statistics are not recorded in the monitor, and
hence, once they disappear from a display, the information is not
further cached, buffered, or otherwise stored, and therefore lost.
In cases where the monitor records displayed information and
presents it in the form of patient health trends, the display of
real time vital statistics is obscured.
[0004] In a hospital environment, patient specific information such
as blood test reports and X-ray reports, among other data, are
generated at sites remote to the patient bedside. Such information
is usually stored in the hospital information system and may be
accessed by caregivers as and when required from a central server.
The caregivers may be required to carry the information in paper
form in order to study/compare it in context with the real time
patient vital statistics. As the volume of paper being carried by
the caregiver increases, the chances of delay in
diagnosis/treatment due to delay in finding a relevant piece of
information, increase as well. Also, some piece of patient
information may not be available with the caregiver at any given
time and may cause a delay or an error in diagnosis and
treatment.
[0005] Hence, there is need for a patient bedside monitor which is
capable of connecting with the hospital information system and
displaying all the information related to a specific patient. There
is need for a bedside monitor which can display all the patient
related information available with the hospital at the same time
and without obscuring the real time display of the patient's vital
statistics. There is need for a smart bedside monitor that can
provide analyses of the patient's health information over a
specified period of time corresponding to any pre-defined criteria
set by a caregiver.
[0006] Furthermore, there is a need for a multi-purpose display
that can be partially under a user's control but not supersede or
compromise critical functions, such as the display of key monitored
physiological parameters or issuance of alarms in relation to
monitored events. The multi-purpose display enables a single
physical display unit to perform multiple functions, thereby
avoiding taking up excessive hospital room space by additional
display units, while not undermining, sacrificing, or compromising
the core function of a physiological display.
SUMMARY OF THE INVENTION
[0007] The present specification is directed toward a dual display
bedside monitor that is connected to a hospital information system
and has the capability to simultaneously display real time patient
waveforms and vital statistics as well as provide a display for
local and remote software applications.
[0008] In one embodiment, the present specification is directed
toward a system for measuring and displaying a multitude of patient
physiological parameters using dual displays at the bedside
comprising the following: a patient monitoring system containing
various ports for connection of a multitude of physiological
parameter measuring devices; a dual display device connected to
said patient monitoring system; a database in communication with
said patient monitoring system; a hospital information system in
communication with said dual display device and said database; and,
a plurality of laboratories in communication with said hospital
information system.
[0009] In one embodiment, the physiological parameter measuring
devices include ECG, IBP, NIBP, SpO.sub.2, cardiac output,
temperature, capnography, BIS, SvO.sub.2, and EEG measuring
devices.
[0010] In one embodiment, the dual display device comprises a
separate primary display and a separate secondary display. In
another embodiment, the dual display device comprises a single
display with a first screen area dedicated as a primary display and
a second screen area dedicated as a secondary display. In yet
another embodiment, the dual display device comprises a separate
primary display and a tablet PC that acts as a separate secondary
display which connects to the patient bedside monitor.
[0011] In various embodiments, the separate primary display,
separate secondary display, and single display each measure 19
inches diagonally. In other embodiments, the displays each measure
22 inches diagonally. In another embodiment, the separate primary
display measures 19 inches diagonally and the separate secondary
display measures 22 inches diagonally. In yet another embodiment,
the separate primary display measures 22 inches diagonally and the
separate secondary display measures 19 inches diagonally.
[0012] In various embodiments, the separate primary display,
separate secondary display, and single display each have a screen
resolution of 1280.times.1024 pixels. In another embodiment, the
separate primary display has a screen resolution of 1024.times.768
pixels and separate secondary display has a screen resolution of
1280.times.1024 pixels.
[0013] In one embodiment, the primary display continuously renders
measured real time patient waveforms and vital signs and the
secondary display renders user specified applications. In another
embodiment, both the primary and secondary displays are capable of
rendering user specified applications but the primary display is
reserved for real time monitoring when an event of significance
occurs. In another embodiment, both the primary and secondary
displays are capable of rendering real time monitoring information
during an event of significance.
[0014] In one embodiment, in which there is only a single display,
the entirety of the single display is capable of rendering user
specified applications. In one embodiment, the user specified
applications are minimized during an event of significance,
allowing real time monitoring information to be displayed. In
another embodiment, a message is displayed on top of the user
specified applications, and said user specified applications are
minimized if said message is not acknowledged within a
predetermined period of time, allowing real time monitoring
information to be displayed. In yet another embodiment, the user
specified applications are minimized after a predetermined period
of inactivity, allowing real time monitoring information to be
displayed. In various embodiments, the predetermined period of time
is 1, 3, 5, or 15 minutes.
[0015] In one embodiment, an event of significance refers to a
plurality of caregiver-predetermined states or scenarios, or occurs
whenever a set of values falls outside caregiver-predetermined
thresholds or rules. In one embodiment, events of significance are
managed by a clinical context manager. In one embodiment, the
clinical context manager, based upon the current clinical context,
launches local or remote applications.
[0016] In one embodiment, the primary display further renders alarm
state and technical and medical status information. In one
embodiment, the user specified applications rendered by the
secondary display comprises information aggregated from said
database and said hospital information system. The user specified
applications rendered by the secondary display can also comprise
local and remote software applications. A plurality of user defined
widgets is used to access aggregate data or launch applications.
The local and remote software applications can comprise one or more
of the following: entertainment software, internet or other network
connectivity, patient education software, email applications, and
video conferencing applications. In one embodiment, the local
software applications are hosted on the dual display bedside
monitor. In one embodiment, the remote software applications are
hosted on a remote computing device such as a separate bedside
monitor, a central workstation, or a physician's office PC.
[0017] In one embodiment, the dual display device runs in patient
mode when a caregiver is not present and runs in caregiver mode
when a caregiver is using the system. Clinical settings are
inaccessible while the system is in patient mode. The caregiver has
access to clinical settings while the system is in caregiver mode.
A caregiver is able to gain access to caregiver mode by entering a
credential or password, or by swiping an RFID badge.
[0018] In one embodiment, the database comprises at least one
storage memory that resides locally within said dual display device
and at least one storage memory that resides externally from said
dual display device.
[0019] In one embodiment, the present specification is directed
toward a method for measuring and displaying a multitude of patient
physiological parameters using dual displays at the bedside
comprising the following steps: measuring a plurality of patient
physiological parameters using a multitude of measuring devices
attached to a bedside patient monitoring system; transmitting
measured data from said patient monitoring system to connected dual
display device; displaying real time information on a primary
display of said dual display device; additionally transmitting said
data from patient monitoring system to a connected database for
storing; transmitting some or all of stored data from said database
to a hospital information system; transmitting additional patient
information gathered from a plurality of laboratories to said
hospital information system; and, displaying remote software
applications and information aggregated from said database and
hospital information system on a secondary display of said dual
display device.
[0020] In one embodiment, real time patient vital statistics, alarm
states, and technical and medical status are continuously displayed
on said primary display of said dual display device. Some or all of
the real time data is concurrently stored on the database. The
stored data is transmitted from the database to the hospital
information system via standard output formats such as HL7,
Mcdibus. In one embodiment, the stored data is transmitted from the
database to the hospital information system at predetermined
intervals. In one embodiment, the stored data is accessed via
customizable queries to the database.
[0021] In another embodiment, the present specification discloses a
display system for displaying critical patient data and/or
non-critical data, comprising: a plurality of ports configured to
connect said display system to a plurality of physiological
parameter measuring devices; at least one port configured to
connect said display system to at least one network; a display
screen comprising a plurality of pixels divided into a first
display region and a second display region, wherein said first
display region displays data from a first video buffer and wherein
said second display region displays data from a second video
buffer; and a controller for directing non-critical data to said
first video buffer and said second video buffer, wherein, in
response to a triggering event, said controller stops directing
non-critical data to the first video buffer and directs critical
patient data to the first video buffer.
[0022] Optionally, the triggering event is at least one of an
alarm, a physiological parameter exceeding a predefined threshold,
a passage of time, a physiological parameter falling below a
predefined threshold, or a detected disconnection of a sensor. In
response to the triggering event, the controller automatically
stops directing non-critical data to the first video buffer and
directs critical patient data to the first video buffer. The
detected disconnection of a sensor comprises a disconnected ECG
electrode. The physiological parameter falling below a predefined
threshold comprises a weakening pulse oximeter signal. The
non-critical data comprises laboratory data, prescribed medication,
patient educational data, advertising, historical patient health
status, historical alarm data, video data, audio data, or email
data. The non-critical data is transmitted to the display system,
via the at least one network and said at least one port, from a
remotely located database. The critical patient data comprises at
least one of data a) indicative of a patient's health status
requiring immediate attention from a health care provider, b)
indicative of a patient's health status which should be brought to
the attention of a health care provider but which is not
time-critical, or c) designated by a health care provider as
requiring substantially constant display. The physiological
parameter measuring devices comprise ECG, blood pressure,
SpO.sub.2, cardiac output, temperature, capnography, BIS,
SvO.sub.2, or EEG measuring devices.
[0023] In another embodiment , the present specification discloses
a display system for displaying critical patient data and
non-critical data, comprising: a plurality of ports configured to
connect said display system to a plurality of physiological
parameter measuring devices; at least one port configured to
connect said display system to at least one network; a display
screen comprising a plurality of pixels divided into a first
display region, having a first pixel count, and a second display
region, having a second pixel count, wherein said first display
region displays data from a first video buffer and wherein said
second display region displays data from a second video buffer; and
a controller for directing non-critical data to said first video
buffer and for directing critical patient data to said second video
buffer, wherein, in response to a triggering event, said controller
decreases the first pixel count, thereby decreasing the first
display region size, and increases said second pixel count, thereby
increasing said second display region size.
[0024] Optionally, the triggering event is at least one of an
alarm, a physiological parameter exceeding a predefined threshold,
a passage of time, a physiological parameter falling below a
predefined threshold, or a detected disconnection of a sensor. In
response to the triggering event, the controller automatically
stops directing non-critical data to the first video buffer and
directs critical patient data to the first video buffer. The
detected disconnection of a sensor comprises a disconnected ECG
electrode. The physiological parameter falling below a predefined
threshold comprises a weakening pulse oximeter signal. The
non-critical data comprises laboratory data, prescribed medication,
patient educational data, advertising, historical patient health
status, historical alarm data, video data, audio data, or email
data. The non-critical data is transmitted to the display system,
via the at least one network and said at least one port, from a
remotely located database. The critical patient data comprises at
least one of data a) indicative of a patient's health status
requiring immediate attention from a health care provider, b)
indicative of a patient's health status which should be brought to
the attention of a health care provider but which is not
time-critical, or c) designated by a health care provider as
requiring substantially constant display. The physiological
parameter measuring devices comprise ECG, blood pressure,
SpO.sub.2, cardiac output, temperature, capnography, BIS,
SvO.sub.2, or EEG measuring devices. The critical patient data
comprises a predefined set of values generated in real-time from
said physiological parameter measuring devices.
[0025] In another embodiment, the present specification discloses a
method for concurrently displaying non-critical data and a
multitude of patient physiological parameters being monitored in
real-time on a display screen, having a plurality of pixels divided
into a first display region with a first pixel count and a second
display region with a second pixel count, comprising: receiving
monitored data from a plurality of patient physiological
parameters; receiving stored data from at least one data network;
buffering critical patient data in a first video buffer; buffering
non-critical data in a second video buffer; displaying critical
patient data in said first display region, wherein said first
display region is in data communication with said first video
buffer and not said second video buffer; displaying non-critical
data in said second display region, wherein said second display
region is in data communication with said second video buffer and
not said first video buffer; and in response to a triggering event,
decreasing the first pixel count, thereby decreasing the first
display region size, and increasing said second pixel count,
thereby increasing said second display region size.
[0026] Optionally, the triggering event is at least one of an
alarm, a physiological parameter exceeding a predefined threshold,
a passage of time, a physiological parameter falling below a
predefined threshold, or a detected disconnection of a sensor. The
non-critical data comprises laboratory data, prescribed medication,
patient educational data, advertising, historical patient health
status, historical alarm data, video data, audio data, or email
data. The critical patient data comprises at least one of data a)
indicative of a patient's health status requiring immediate
attention from a health care provider, b) indicative of a patient's
health status which should be brought to the attention of a health
care provider but which is not time-critical, or c) designated by a
health care provider as requiring substantially constant
display.
[0027] The aforementioned and other embodiments of the present
invention shall be described in greater depth in the drawings and
detailed description provided below.
BRIEF DESCRIPTION OF THE DRAWINGS
[0028] These and other features and advantages of the present
specification will be further appreciated, as they become better
understood by reference to the detailed description when considered
in connection with the accompanying drawings:
[0029] FIG. 1 is a block diagram illustrating an environment in
which the dual display monitor is used, in accordance with an
embodiment of the present invention;
[0030] FIG. 2 illustrates a patient monitoring system, as shown in
FIG. 1, that is employed, in one embodiment, to support and/or
control dual display functionality;
[0031] FIG. 3 is a block diagram illustrating screen size and usage
differences of the dual display monitor among multiple embodiments
of the present invention;
[0032] FIG. 4 illustrates the rear panel of a patient monitoring
system that is employed, in one embodiment, to support and/or
control dual display functionality;
[0033] FIG. 5 illustrates a block diagram of the video
configuration of the dual display monitor, in accordance with an
embodiment of the present invention;
[0034] FIG. 6 illustrates a block diagram of the power
configuration of the patient monitoring system that is employed, in
one embodiment, to support and/or control dual display
functionality;
[0035] FIG. 7 illustrates a block diagram of the data access and
display architecture of one embodiment of the present
invention;
[0036] FIG. 8 illustrates an architectural block diagram of the
dual display monitors, in accordance with an embodiment of the
present invention;
[0037] FIG. 9 illustrates an architectural block diagram of the
dual display monitors, in accordance with another embodiment of the
present invention;
[0038] FIG. 10 is a flowchart illustrating the events that take
place upon activation of a widget on a display monitor, in
accordance with an embodiment of the present invention; and
[0039] FIG. 11 illustrates a plot of hemodynamic indices displayed
on a display monitor, in accordance with an embodiment of the
present invention.
DETAILED DESCRIPTION OF THE INVENTION
[0040] The present specification provides a dual display monitor
which can be set up at a patient bedside to provide aggregated
medical information related to the patient along with the patient's
real time vital statistics. One of the two displays continuously
shows the real time patient monitoring information whereas the
other is used to display information such as when medicines were
delivered, show lab results in reference to vital signs, and
provide access to other remote hospital applications, typically
only accessible via separate data terminals. The dual display
monitor is connected to the hospital information system and has the
capability of displaying local software applications and remote
software applications via remote display software, such as,
software made available by Citrix.TM.. In addition, the dual
display monitor can be connected to a central monitor configuration
that can include up to four additional displays. These additional
displays can be used to monitor more patients, display additional
data, and/or host other applications.
[0041] The present specification is directed towards multiple
embodiments. The following disclosure is provided in order to
enable a person having ordinary skill in the art to practice the
invention. Language used in this specification should not be
interpreted as a general disavowal of any one specific embodiment
or used to limit the claims beyond the meaning of the terms used
therein. The general principles defined herein may be applied to
other embodiments and applications without departing from the
spirit and scope of the invention. Also, the terminology and
phraseology used is for the purpose of describing exemplary
embodiments and should not be considered limiting. Thus, the
present specification is to be accorded the widest scope
encompassing numerous alternatives, modifications and equivalents
consistent with the principles and features disclosed. For purpose
of clarity, details relating to technical material that is known in
the technical fields related to the invention have not been
described in detail so as not to unnecessarily obscure the present
invention.
[0042] FIG. 1 is a block diagram illustrating an environment in
which the dual display monitor is used in accordance with one
embodiment of the present invention. The dual display monitor 102,
comprising a first display monitor 110 and a second display monitor
112, is installed by a patient's bedside and is connected to the
patient monitoring system 101 through a display manager 105
included within said patient monitoring system 101. In various
embodiments, the patient monitoring system 101 includes ports for a
plurality of measuring devices, which includes but is not limited
to, ports for blood pressure monitoring systems, heart rate
monitoring systems, and pulse oximeter monitoring systems. The
display manager 105 interfaces with a local display framework 103
and a remote display framework 104, both of which are also included
within the patient monitoring system 101. The remote display
framework 104 communicates with a remote application 107 which in
turn collects information from a database 108 and a hospital
information system (HIS) 106. The HIS 106 has access to data
received from a plurality of laboratories 109, 109A. Data received
from the laboratories 109, 109A comprises blood test reports, X-ray
scan reports, among other data. The patient monitoring system 101
also interfaces directly with said database 108 and in turn, the
HIS 106.
[0043] Patient monitoring information is fed to database 108 where
the information is sorted and, in one embodiment, a subset of the
information is fed to the hospital information system 106. First
display monitor 110 displays real time patient vital statistics as
obtained from the patient monitoring system 101. Real time patient
statistics comprise, for example, numeric data (such as heart rate,
systolic blood pressure, and cardiac output), alarm states (when a
patient's current status violates a preconfigured alarm state) and
other technical and medical status (such as anomalistic weakening
of pulse oximeter signal or disconnection of ECG electrode(s)).
[0044] Database 108 comprises at least one storage memory that
resides locally within the dual display monitor 102 as well as at
least one storage memory external to the monitor 102 residing in
proximity or remotely from the monitor 102. Thus, in one
embodiment, some or all of the patient vital statistics data,
communicated and displayed real-time by first display monitor 110,
is also stored in local data storage residing within the dual
display monitor 102. This locally stored patient data, in one
embodiment, is used to create trend displays and to allow review of
alarm data in clinical context. In one embodiment, at least a
portion of the entire patient vital statistics data stored in local
data storage residing within the dual display monitor is also
available for posting to the hospital information system.
Additionally or in alternate embodiments, some or all of the
patient vital statistics data is communicated over a network for
storage in a database that is external to the dual display monitor
102. The storage capacity of such an external database is typically
large to accumulate data over a long period of time. Persons of
ordinary skill in the art should appreciate that the external
database may reside on a computer/server in proximity to the dual
display monitor 102 and/or on a computer/server remote from the
dual display monitor 102.
[0045] Data from the external database is exported to the hospital
information system 106 using standard output formats such as HL7,
Medibus. In one embodiment, data from the external database is
pushed out to the hospital information system 106 at predetermined
intervals. Additionally, the data is also accessible via queries to
the external database, which in one embodiment, may be
customized.
[0046] Second display monitor 112 displays information aggregated
from the database 108 and the hospital information system 106.
Information such as the patient's health trends, drug effects on
the patient's vital statistics, lab results, among other data, are
displayed on the second display monitor 112, provided by at least
one or more underlying local or remote software programs. Hence,
the information displayed on the second display monitor 112 enables
caregivers to understand and analyze the patient's progress and
response to drugs and hence, effectively respond to changes in the
patient.
[0047] In one embodiment, local and remote software applications
accessed on the dual display monitor 102 enable viewing of patient
data stored in the external database in a way that enhances
monitoring functionality at the patient bedside. For example, an
ECG waveform review application, hosted on the monitor 102, allows
waveform records over the last 72 hours to be reviewed, edited,
forwarded and re-stored. In another example, a database application
enables retrieval of readings from laboratories 109 and trends them
for display. Persons of ordinary skill in the art should appreciate
that such software applications may reside locally or be hosted on
a separate bedside monitor, a central workstation or at a
physician's office PC. In each case the patient data is retrieved
from the external database and the editing session is run on the
appropriately connected computer. Additionally, in further
embodiments, the local and remote software applications accessed on
the dual display monitor 102 also comprise applications other than
those just related to providing patient monitoring functionality.
For example, such software could be an entertainment; Internet or
other network connectivity; or a patient education application or
an email or video conferencing application or any other value-added
application that would be advantageously evident to those of
ordinary skill in the art. In one embodiment, fixed screen zones
are established for patient applications. For example, patients are
not allowed to cover up vital signs displays or they are restricted
to using the second display monitor 112, in one embodiment, for
email, video conference, or other patient activities.
[0048] In one embodiment, the dual display monitor 102 can be
enabled in either patient mode or caregiver mode. In patient mode
clinical settings cannot be changed but a controlled list of
approved software applications, such as entertainment or patient
education, can be run. The monitor is in patient mode unless a
caregiver is in the room. Thus, for example, when the patient is in
the room unattended the monitor would typically be in patient mode.
The mode can be changed remotely by a caregiver. To change into
caregiver mode the monitor is enabled to take a credential,
password or RFID badge. In one embodiment, context sensitive
disabling or minimization of patient mode is enabled. Thus, in the
event of a change in clinical state [for example a certain alarm
class (high priority)] the patient's application is disabled or
minimized until cleared by a caregiver. Ideally, this would be
configurable by the caregiver by alarm type or alarm class.
[0049] The dual display functionality of the monitor 102 of the
present invention enables optimization between the display of
real-time patient monitoring data and therefore related alarm
contexts and the display of information from local or remote
software applications accessed on the monitor 102.
[0050] Optimization is achieved by providing adequate screen real
estate through a plurality of scenarios, such as, in the following
various embodiments, wherein in a first embodiment, first display
110 is used for full time real-time monitoring while second display
112 is used for full time hosted application viewing. In another
embodiment, first display 110 and second display 112 are both
available for hosted application viewing but first display 110 is
reserved for real-time monitoring when an "event of significance"
occurs. In yet another embodiment, first display 110 and second
display 112 are both available for monitoring during an "event of
significance".
[0051] It should be appreciated that the presently disclosed system
enables critical patient data, defined as data which a) is
indicative of a patient health status requiring immediate attention
from a health care provider or that is otherwise time-critical, b)
is indicative of a patient health status which should be brought to
the attention of a health care provider but which may not be
time-critical, and/or c) is designated by a health care provider as
requiring substantially constant display, to be displayed alongside
non-critical data, defined as data which does not constitute
critical patient data, without compromising the display of the
critical patient data. It should further be appreciated that the
functionality described herein is effectuated by a controller
implementing a plurality of instructions, stored in memory local or
remote from the display, and executed by at least one
processor.
[0052] In another embodiment, there is only one display but a
portion is pre-allocated as application display area. In another
embodiment, there are two, three, four, or more separately
controlled display regions in a single physical display. In another
embodiment, there are two, three, four, or more separately
controlled display regions in two or more physical displays. It
should be appreciated that a display area or region can be a region
of pixels located in one or more physical displays.
[0053] In yet another embodiment, there is only one display and
applications can take all of the screen area but surrender control
during an "event of significance". In this case, it is possible
that a caregiver is running a software application and
hiding/covering some or all of the monitor's real-time vital
information when a patient's status changes. In such cases, in one
embodiment, the monitor is enabled to minimize all applications for
certain types of patient events. Thus, certain events (alarms of a
certain type or priority) automatically minimize all applications
thus displaying the monitoring message. In another embodiment, the
application is left running but a message (which must be responded
to) is posted on top of any and all applications. If the message is
not responded to, then the application is automatically minimized.
Still alternatively, all applications could be minimized
automatically after a configurable time out. Thus, in the event an
application user leaves the application running (covering some or
all of the real-time vitals monitoring functionality), the
application is minimized after a period of no-activity. In various
embodiments, the period of inactivity is set to 1, 3, 5, 15, or any
other user determined value. For example, assuming a 3 minute
inactivity threshold, if a user accesses an application and enters
data for 5 minutes, the application will not minimize because of
the activity. When the user is called away from the monitor, after
3 minutes the application will be minimized automatically.
[0054] Persons of ordinary skill in the art should appreciate that
an "event of significance" could be a plurality of predefined
states/scenarios/thresholds/rules. In one embodiment, an "event of
significance" is user defined (such as, for example, Heart
rate>140 bpm, Systolic blood pressure>150 or <90). In
another embodiment, an "event of significance" is defined by an
arbitrarily complex set of rules to define when non-critical
applications should surrender to the real-time monitor. In yet
another embodiment, the "event of significance" is based on alarm
status (such as: any alarm, any high priority alarm, and any medium
or higher priority alarm). In still yet another embodiment, the
"event of significance" is capable of being overruled by a user.
Thus, a user may override and run an application by deciding that
an alarm is actually not real.
[0055] In one embodiment, "events of significance" related
functions are managed by a software module, hereinafter referred to
as the `clinical context manager` . The clinical context manager
monitors the patient state and continuously compares it to the
rules that have been established (defaults or user defined).
Accordingly, the context manager signals hosted software
applications to be displayed or minimized.
[0056] Further, based on the patient's state, the context manager
can trigger additional activities, which may be default behaviors
or they may be configured by the user. They may be configured based
on alarm type or severity, or they may be based on clinical indexes
that are currently being monitored. The additional activities that
are triggered may be of several different types, such as, but not
limited to, the following: [0057] a) logging additional data into
the local or external database [0058] b) launching an application
that retrieves additional information from a local or external
database and presents the current state in a clinical context in
the application area. [0059] 1. For example, where a patient's
blood pressure is dropping gradually, the patient's change in state
is noted by the clinical context manager and an application is
launched that retrieves the complete blood pressure history and
plots the recent change in context to the historical record. This
data is displayed in the application window. [0060] 2. Where a
patient is a diabetic, a user may select a default clinical context
of diabetes for this patient (or it may be selected automatically
if the diabetes diagnosis was retrieved from a health record).
These activities are user configurable. Part of the "diabetes"
clinical context default rules may be to retrieve most recent blood
sugar reading in the event of successive low pressure readings. In
this case, multiple low readings would trigger an application to
retrieve the extended blood pressure history and the extended
laboratory and blood draw data and present this data in an
application window. A clinician who then checked on the patient
would see the current monitoring status and the relevant data
presented in a clinically appropriate manner. [0061] 3. In another
example, the primary display is displaying ECG, SpO2 and NIBP
values for a patient. Initially, the patient is in normal sinus
rhythm but over time begins to develop an increasing number of
abnormally conducted beats. The clinical context manager launches a
trending application (either locally on the monitor or on a remote
workstation) that renders a trend graph of the number of abnormal
beats versus time for the last few hours. This trend will draw the
attention of the caregiver to a parameter that the clinical context
manager has determined is changing. [0062] 4. In yet another
example, the clinical context manager will launch a trending
application if a patient's mean heart rate increases by more than
15%. In this example, the trending application will display the
patient's heart rate for the last 6 hours and render the data at 30
second resolution with updates in real time.
[0063] FIG. 2 illustrates a patient monitoring system, as shown in
FIG. 1, that is employed, in one embodiment, to support and/or
control dual display functionality; The patient monitoring system
200 supports the connection of two display units such as video
display units (VDU), liquid crystal display (LCD) screen, among any
other display type known in the art. The patient monitoring system
200, which in one embodiment comprises first module 205 and second
module 225, is provided with a plurality of ports on a panel 201
for enabling connection with display units, a hospital database,
and other networks.
[0064] First module 205 comprises a plurality of ports that provide
interfaces to patient connected cables, transducers or sensors. In
one embodiment, port 202 is the connector for an ECG cable. This
cable is connected to the electrodes on the patient and ECG
analysis is performed by the patient monitor. In one embodiment,
port 204 is a connector for an Invasive Pressure cable. This cable
is connected to a catheter placed inside the patient.
[0065] In one embodiment, port 206 is a connector for connecting an
appropriate SpO.sub.2 cable. The cable is connected to a SpO.sub.2
sensor and attached to the patient. The pulse oximeter function is
inside the patient monitor.
[0066] In one embodiment, port 208 is a connector for a cardiac
output cable, which would attach to a catheter put into the
patient. The cardiac output analysis is performed by the patient
monitor.
[0067] In one embodiment, port 209 is a connector for a dual
temperature cable. The temperature analysis is performed by the
patient monitor.
[0068] In one embodiment, port 212 is a high level output designed
to provide an external analog interface to an ECG or Invasive
pressure waveform.
[0069] In one embodiment, port 214 is a connector to an adult NIBP
adapter hose.
[0070] In one embodiment, port 216 is a connector to a neonatal
NIBP adapter hose.
[0071] In one embodiment, button 218 is provided to enable a "Stop"
NIBP control.
[0072] In one embodiment, ports 210 and 226 of second module 225
are related to a capnography gas analyzer. Port 210 is a connector
which attaches to the patient for mainstream capnography. Port 226
is a connector for side stream capnography. The second module 225
could be used for any of a number of different specialty monitoring
applications such as BIS (bispectral index), SVo2 or EEG, as
manufactured by Spacelabs Healthcare LLC.
[0073] Persons of ordinary skill in the art should appreciate that
the patient monitoring system 200 of the present invention allows
appropriate interfaces for connectivity to additional and/or
alternate medical/patient monitoring devices that are manufactured
by third party vendors. For this purpose, a plurality of
connections or ports may be provided a panel of the patient
monitoring system 200, hereinafter referred to as flexports or data
interfaces, to third party devices or networks. For example, there
could be a case where a particular respirator or a pulse oximeter
made by a third party vendor/manufacturer needs to be used. For
devices which use the flexport interface, the data is then
displayed on the patient monitoring system 200 (such as in the form
of waveforms, numeric data, indices and/or alarms) and can be
trended and reviewed along with the other data. Data from these
flexport devices can also be exported to an external database (as
described with reference to database 108 of FIG. 1). Similarly,
connections to a network and connections to the two video outputs
for the display monitors can be found on the back panel.
[0074] In one embodiment, and as mentioned with respect to FIG. 1,
the dual display monitor 200 supports a first display unit and a
second display unit, which in one embodiment are 19 inches with a
4.times.3 ratio, and wherein the resolution of real-time patient
monitoring display is 1024.times.768 and that of software
application display is 1280.times.1024 pixels. In another
embodiment, the two display units measure 22 inches diagonally and
have a 16.times.9 (wide aspect) ratio. FIG. 3 is a block diagram
illustrating screen size and usage differences of the dual display
monitor among multiple embodiments of the present invention. In one
embodiment, in which both display units measure 22 inches, both
display units have a resolution of 1280.times.1024 pixels. In one
embodiment, in which both display units measure 22 inches, the
vertical screen height of both monitors is approximately the same
as that of the 19 inch display units, and the extra horizontal
screen space 305 is reserved for widgets. In one embodiment, the
vertical screen height of the 22 inch display units differs from
that of the 19 inch display units by +/-0.2 inches. In an
embodiment, a single mouse control and a single keyboard control is
provided as input devices for both the displays. Input may also be
provided via `touch screen` functionality provided to the two
displays.
[0075] In an embodiment, the application display presents remote or
virtual applications. In various embodiments, there are a number of
controls that allow caregivers to decide how they want to see the
information. In an embodiment, caregivers may preset the
application display screen. For example, if all cardiologists want
to see the same data, the application display screen may be preset
to a standard cardiology data display. A caregiver may choose an
option entitled `cardiology` and obtain all cardiology related
information available with the hospital information system with or
with-out any specific patient context. In an embodiment options
presented on the monitor screen may be selected by using voice
recognition technology based on radio frequency identification
(RFID).
[0076] In various embodiments the application display screen is a
multi-purpose device/monitor that may be used as a high definition
television (HDTV), as a user interface for sending emails, as an
interface for patient education, as a user interface for running
bedside applications (patient entered data such as pain score), as
a screen for playing video games, for conducting mental acuity
tests, among other optional activities. In an embodiment, the
application display can be a tablet PC that is provided to a
clinician that connects to patient bedside monitor. Thus, the
second display may not be on the monitor 200, but may be provided
remotely to the caregiver.
[0077] Referring again to FIG. 2, a power switch 222 is provided on
a panel for turning the dual display monitor 200 on or off In one
embodiment, the power switch 222 is secured to the power supply
board by elastomer prongs and is positioned between the power
supply board and a panel bezel. The power switch 222 is back lit
for enabling easy viewing of the monitor's power status. An extra
universal serial bus (USB) port 224 is provided on a side of the
front panel 201 for connecting any ancillary monitoring device or a
supported USB accessory.
[0078] FIG. 4 illustrates the rear panel of a patient monitoring
system that is employed, in one embodiment, to support and/or
control dual display functionality. As discussed above, a panel of
the patient monitoring system may contain a plurality of flexports
or data interfaces for connectivity to additional and/or alternate
third party patient monitoring devices. In one embodiment, a panel
includes an audio output port 402 and an alarm relay output port
403. The panel also includes a first DVI video output port 404 and
a second DVI video output port 405 for a second independent
display. A VGA video output port 406 is also included for
connecting a display. The panel additionally includes serial port
407 and another serial port 408 for an external touchscreen. Two
USB-A ports 409 and an Ethernet port 410 are also included. The
panel includes an equipotential terminal 411, SDLC terminator
switch 412, SDLC/Power output 413, and high level analog output
414. In addition, the panel contains a DC power input port 415 for
connection of a power cable to the patient monitoring system.
[0079] FIG. 5 illustrates a block diagram of the video
configuration of the dual display monitor 500, in accordance with
an embodiment of the present invention. A PCI data bus 501 carries
data transmitted from a processor to one of two displays, a primary
display 505 and a secondary display 510. With respect to the
primary display 505, the PCI data bus 501 interfaces with a
processing unit 504 which is in data communication with oscillator
502 and memory 503. The processing unit 504 processes data for
display and transmits it to a video buffer 507 and display driver
506. Display data is then interfaced to the primary display 505 via
an interface 508.
[0080] Similarly, with respect to the secondary display 510, the
PCI data bus 501 interfaces with a PCI interface unit 511, which
interfaces with PCI interface unit 512 and communicates with
processing unit 515, which is in data communication with an
oscillator 513 and memory 514. The processing unit 515 processes
data for display and transmits it to a video buffer 516 and display
driver 517. Display data is then interfaced to the primary display
510 via an interface 518.
[0081] The architecture of the Dual Display system enables improved
data access and an integrated display of data from multiple
sources. In various embodiments the graphical user interface (GUI)
of the display comprises a plurality of widgets with which a user
(a caregiver or a patient) may interact. In one embodiment, the
widgets are displayed as borderless windows or icons. In one
embodiment, the widgets are set to a predefined location. In one
embodiment, the widgets are non-resizable. Examples of the widgets
comprise widgets for displaying patient health trends, lab data,
event triggers, alarm history, clinical data, treatment protocols,
launching clinical applications, launching hospital applications,
or printing data.
[0082] In an embodiment, Windows Dynamic Network Access (WinDNA)
provides access to custom applications running at fixed screen
locations via the dynamic network access (DNA). Thus, in one
embodiment, DNA is a software application that allows third party
applications (such as, but not limited to HIS) running on another
computer to host a session on the bedside monitor. The data to
drive the display and to interact with the user at the display is
exchanged via a network configuration.
[0083] Thus, WinDNA allows users to view and control Windows
applications on the display. Input to the WinDNA can be done using
a mouse, a keyboard, and via touch-screen. In one embodiment, a
thin-client, embedded in the DNA-enabled display, allows the users
to launch applications installed on the server using the hospital's
existing network infrastructure.
[0084] FIG. 6 illustrates a block diagram of the power
configuration 600 of a patient monitoring system that is employed,
in one embodiment, to support and/or control dual display
functionality. In one embodiment, the power configuration 600
includes a power supply component 610 and a backplane component
640. The power supply component 610 and backplane component 640
interface via two separate connections. The first connection is an
interface between a Power Supply I/F Connector 642 on the backplane
component 640 and a Backplane I/F Connector 612 on the power supply
component 610. The second connection is an interface between an
SDLC Connector 644 on the backplane component 640 and an SDLC
Connector 614 on the power supply component 610.
[0085] Referring now to the power supply component 610, the
Backplane I/F Connector 612 interfaces with a CPU I/F Connector 616
through two power regulators 618 and a Power Fail
[0086] Detect circuit 620. Additionally, the CPU I/F Connector 616
has a USB interface with a USB Connector 622 on the power supply
component 610. Further, the power supply component 610 includes a
Momentary Switch 624 which interfaces with a Switch Debouncer
Circuit 626, which, in turn interfaces with a Data or Delay
Flip-Flop (D-FF) Circuit 628. The D-FF 628 interfaces with the SDLC
Connector 614 on the power supply component 610.
[0087] Referring now to the backplane component 640, the Power
Supply I/F Connector 642 interfaces with a Lower Bay SDLC Connector
646 and an Upper Bay SDLC Connector 650 both directly and through a
power regulator 648. Both the Lower Bay SDLC Connector 646 and
Upper Bay SDLC Connector 650 interface with additional power
regulators 648. The Power Supply I/F Connector 642 also interfaces
with an External SDLC Connector 652 through an 18V En. 654 and 18V
Connector 656. The SDLC Connector 644 on the backplane component
interfaces directly with the Lower Bay SDLC Connector 646, Upper
Bay SDLC Connector 650, and External SDLC Connector 652. Further,
the SDLC Connector 644 also interfaces with the External SDLC
Connector through a power regulator 648.
[0088] Referring to FIG. 7, a display 701 comprises a data display
region 702, a plurality of data access buttons 704, 705, 706, 707,
and a fixed region 703 that displays data accessed when the data
access buttons 704, 705, 706, 707 arc activated. For example, when
a trend button 704 is pressed or actuated, a command is transmitted
to a virtual PC 708 which causes an application corresponding to
conducting trend analyses to execute and access, retrieve, or
otherwise obtain data from a database 709. The accessed data is
then communicated to a second server 710, which formats the
accessed data for display in region 703. In one embodiment, the
display of region 703 is controlled entirely by the second server
710. It should be appreciated that each of the buttons 704, 705,
706, 707 correspond to executing an application, which is stored in
the memory of the virtual computer 708 and executed by a processor
in the virtual computer 708. In one embodiment, the data access
button 704, 705, 706, or 707 for whichever application is running
is highlighted to inform the user which application is being
displayed. It should further be appreciated that the buttons can be
configured to cause applications on the Virtual PC to access data
relevant to patient health trends, lab data, event triggers, alarm
history, clinical data, or protocols, to launch checklists, to
launch clinical applications, to launch hospital applications, or
to print data.
[0089] In one embodiment, the buttons are caused to be displayed by
a monitor that, upon boot up, accesses an XIVIL configuration file
which defines button location, size, graphic, text, what executable
application on a remote PC is related to the displayed button,
context parameters to pass, behavior of WinDNA at launch, such as
fixed, float, border size, among other parameters.
[0090] Referring to FIGS. 8 and 9, which are architectural block
diagrams of the dual display monitors, a top layer application
class is driven by display, window manager, and event manager
objects. The event manager object is further dependent upon various
inputs, such as a mouse, cursor, and keyboard.
[0091] FIG. 10 is a flowchart illustrating the events that take
place upon activation of a widget on a display monitor. A widget,
such as a trend, alarm, or other data access button, is activated
1002. In an embodiment, widget activation triggers 1004 an event
that launches an application with respect to a specific patient.
The launched application 1006 runs on a virtual processing machine
(computer). The application extracts 1008 data from a sorting
database in which data obtained from patient bedside monitoring
systems is stored. The extracted data 1010 is presented in the
format of the application user interface on the display monitor via
WinDNA.
Exemplary Use I
[0092] In one exemplary use, a 42 year old male motor cycle
accident victim is mechanically ventilated in the Surgical
Intensive Care Unit (SICU) of a large urban hospital. He suffered a
ruptured spleen which was removed; fractured left leg, left arm,
left ribs T6-9; and currently is in respiratory and renal failure.
During the first 48 hours of admission he required high oxygen
concentrations for severe hypoxemia which precipitated acute
respiratory distress syndrome (ARDS). The critical trauma patient
is diagnosed with multiple organ system failure and ARDS and is
placed on permissive hypoxia protocol to prevent further damage
from oxygen toxicity due to high fraction of inspired oxygen
(FiO.sub.2) settings on a ventilator.
[0093] The physician has written an order for oxygen weaning
protocol (permissive hypoxia); the patient is on a cardiac monitor
with clinical agent application and mechanical ventilation with
supplemental oxygen. Minimal FiO.sub.2 settings are maintained
(O.sub.2 concentration less than 40%) on the ventilator for
improved patient outcome (less lung injury from prolong high level
oxygen therapy) and fewer SICU days. The oxygen weaning protocol
ordered by the physician is displayed on the dual display monitor
when the protocol widget is actuated. The protocol may be displayed
in the second or fixed region of the monitor as "keep SpO.sub.2
less than 92% but greater than 88% by decreasing ventilator O.sub.2
concentration by 2% no more than once per hour."
[0094] In an embodiment, this protocol is displayed in the basic
clinical agent format and may (or may not) flash alerts when
SpO.sub.2 protocol levels are reached to hasten nurse/respiratory
therapist work flow and more efficiently generate patient treatment
which in turn may decrease number of SICU days. Without the
protocol display, the nurse/therapist will have to locate protocols
by time consuming searches through multiple files and, patient
treatment and work flow would be less efficient.
Exemplary Use II
[0095] In another embodiment, a 78 year old female patient is
awaiting ablation evaluation in Critical Care Unit (CCU), and
persists with frequent episodes of Atrial fibrillation (AFib)
lasting in excess of an hour. The patient is in CCU for evaluation
of LA ablation to treat chronic persistent atrial fibrillation. She
is on a cardiac monitor with ECG algorithm, oxygen at 2 L/min nasal
cannula and has a history of dizziness, shortness of breath and
fatigue.
[0096] The physician has written an order for AFib Burden Protocol
while awaiting results for ablation evaluation. The patient has
been classified as Class II-A for AFib and takes aspirin 81 mg,
digoxin 0.14 mg and atenolol 50 mg daily. She has a peripheral IV
maintenance line for access. The patient was safely treated
pharmacologically for reversible episodes of A Fib. Her physician
has placed her on his protocol of treatment for her specific
classification and evidence of complications. The following
protocol displays on the dual display monitor whenever the ECG
algorithm detects A Fib and begins to track the amount of time A
Fib is consistently present: "after 30 minutes of consistent A Fib,
give 150 mg of amiodarone slow IVP (over 10 minutes) if PFTs with
DLCO are on file, if no PFTS with DLCO, then give 20 mg/min
procainamide until 17 mg/kg dose is reached or until resolution of
A Fib or until bradycardia (whichever occurs first)." The dual
display monitor would also flash when the ECG rhythm returns to
normal. Without the protocol display, the nurse will have to locate
protocols by time consuming searches through multiple files and
patient treatment and work flow would be less efficient.
Exemplary Use III In another embodiment, a 66 year old male was
receiving treatment for alcoholic pancreatitis in the ICU of an
urban hospital and experienced a heart attack. The patient is on a
cardiac monitor with IV access. As the patient went into
Ventricular fibrillation (V Fib) and the cardiac monitor began to
sound an alarm, the attending nurse selected the Cardiopulmonary
resuscitation (CPR) protocol button on the dual display monitor.
The dual display monitor displayed the following: (1) the current
Advanced Cardiac Life Support (ACLS) reference flowchart for
decision making, (2) CPR medications calculated for this patient's
current weight and (3) a reference diagram with index of their
hospital's crash cart to aid in the location of medications and
supplies. From the onset of CPR the on screen ACLS reference card
was used for decision making and saved valuable time since the
physician did not need to locate his card. The medication list was
also time efficient as it was clearly displayed and patient
specific.
[0097] As CPR progressed, the patient became more difficult to bag
and mask ventilate, and the physician was unable to intubate. The
decision was made to use an LAM device to ventilate the patient but
the respiratory therapist could not locate one on the crash cart.
Using the dual display monitor and index of the crash cart, the
respiratory therapist was able to identify the location of the LAM
device so it could be used to ventilate the patient until an
anesthesiologist could arrive to intubate. After 27 minutes of
effective and efficient CPR the patient was stabilized and placed
on a ventilator.
[0098] Using the physician's pocket ACLS card to direct care is the
standard of care, but slows the process when the card is misplaced
or difficult to read from age. Displaying ACLS protocol adjacent to
the cardiac monitor on the DNA monitor is more time efficient
during a critical procedure, allows for online medication
calculations and improves readability. Searching a crash cart for
supplies is a slow process and in the heat of the moment
infrequently used items can be over looked. Without the on screen
display and index of the crash cart, the LAM device would not have
been found and effective ventilation could not have been performed
which may have altered the patient outcome.
Exemplary Use IV
[0099] In another embodiment, a cardiologist has a complex chronic
heart failure patient in
[0100] CCU with multiple intravascular lines in place on multiple
medications to manage preload and after load. The cardiologist
seeks to visualize and assess the effect of treatment options on
hemodynamic indices. The patient is on a cardiac monitor with a DNA
display, PA line and/or other device interfaces (such as USCOM) for
continuous or episodic hemodynamic measures.
[0101] A 68 year old male patient with seven year chronic
congestive heart failure history presents with both right and left
side heart failure. Measures are available for SVI, CI, RVSWI,
LVSWI, PVR, and SVR over a 24 hour period for a three day course of
medication administration. The physician wants to plot the
hemodynamic indices. Using the grid illustrated in FIG. 11, the
dual display monitor interfaces with the data collection devices of
the cardiac monitor and plots the hemodynamic values 1100. Without
the data grid display, the physician will have to locate data by
time consuming searches through multiple files and patient
treatment and work flow would be less efficient.
[0102] Hence the dual display monitors may be used by clinicians or
caregivers for accessing physiological waveforms and measurements
as well as real time patient related information at the point of
care (i.e., patient bedside) in order to provide speedy and
accurate diagnosis and treatment.
Exemplary Use V
[0103] A 62 year old man is admitted to the emergency room due to a
fainting episode at home. He is monitored while a number of
different tests are run. While he is being monitored the clinical
context manager is alerted that he has had two episodes of cardiac
pause events that lasted 2.6 and 3.1 seconds; each of these events
is posted to the external database. The monitor is configured to
launch an application that reviews this data and retrieves the
recommended clinical protocol which is to seek a cardiology
consultation and to consider an implantable defibrillator. When the
clinician returns to check on the patient she discovers the
application displaying the recent event along with the suggested
next steps.
[0104] The above examples are merely illustrative of the many
applications of the system of the present invention. Although only
a few embodiments of the present invention have been described
herein, it should be understood that the present invention might be
embodied in many other specific forms without departing from the
spirit or scope of the invention. Therefore, the present examples
and embodiments are to be considered as illustrative and not
restrictive, and the invention may be modified within the scope of
the appended claims.
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